The fourth year of medical school is jam-packed with expectations, one of the biggest being matching with a residency program. Not matching, then, can leave graduating medical students wondering what went wrong and how to deal with it.
An AMA webinar explored the emotions and assessments that accompany not matching, as well as potential adjustments. It featured concrete steps to take in both the immediate aftermath and the ensuing months to improve your chances the next time around.
“There are many different reasons why a match doesn't happen,” said Hilary Fairbrother, MD, MPH, an emergency physician and vice chair of education at the John P. and Kathrine G. McGovern Medical School in Houston. “But when it doesn't happen, it's important to give yourself grace, because this is an imperfect process, and this is a really big, negative thing to happen to you.”
Once you’re over the initial disappointment, you need to determine why you didn’t match and then figure out what you can do differently over the next year, advised Dr. Fairbrother, who is chair of the AMA Young Physicians Section.
“Working hard, improving yourself is really critical,” she said. “Especially if you have some things about yourself that you really feel like you want to change. Maybe it's that you never check your email. Maybe it's that you don't work out every day. Maybe you eat poorly—whatever … it is that's detracting from your life.”
Self-improvement also demonstrates to others that you’re resilient and undeterred, she noted.
“What a great idea, to take something that didn't go right—you didn't match—and now you're going to make yourself better,” Dr. Fairbrother said. “It's a great transformative process, if you let it be.”
It’s also important to continue building your CV, and that means keeping an eye on the calendar, said Afifa Adiba, MD, a child and adolescent psychiatrist at Sheppard and Enoch Pratt Hospital, outside Baltimore.
Dr. Adiba, an AMA member, was an international medical graduate (IMG) who did not match on her first try after arriving from her native Bangladesh. On her second try, she matched at University of Mississippi Medical Center, in Jackson.
“I always write down on a piece of paper what I'm trying to achieve and how I'm going to get there,” she said. “After that, I try to set realistic goals.”
If, for example, she knew she needed to take the USMLE Step 2 exam and she wanted to take the test in three months, she would first figure out how much material she has to cover, Dr. Adiba said. She would then divide it over the intervening weeks.
“I try to be realistic,” she added. “I don't want to say, ‘Okay, I'm going to complete this entire chapter in a day,’ because maybe that is not possible with my life. I have kids. I have a husband. I have other responsibilities. … So make a realistic schedule which you can follow, and if you cannot finish something today, that’s fine. There's always tomorrow.”
She also advised culling your list of goals to those of the highest value to residency programs.
“Focus on one or two things” that are lacking in your CV, she said. “You cannot go in so many directions. … Pause, think what you want, write it down and go from there.”
A third speaker, Jacky Kwong, MD, failed to match in his fourth year at Medical College of Wisconsin. He is now in the third year of a general surgery residency at Rush University, in Chicago.
Drs. Adiba, Fairbrother and Kwong also discussed the challenges unique to IMGs and DOs, the pros and cons of clinical observerships and jobs in research, ways to manage stress and the importance of networking.